3 Steps to Treating Exocrine Pancreatic Insufficiency

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If your pancreas doesn’t produce the enzymes you need for proper digestion, you have what's called exocrine pancreatic insufficiency (EPI). It's a treatable condition, but to best understand your treatment options, it helps to first have a working knowledge of the condition itself.

“EPI is malnutrition specifically linked to the failure of the pancreas,” says David C. Whitcomb, MD, PhD, chief of the division of gastroenterology, hepatology, and nutrition, and medical director of the Comprehensive Pancreas Program in the Liver-Pancreas Institute at the University of Pittsburgh and University of Pittsburgh Medical Center. EPI can also cause gastric discomfort, weight loss, and diarrhea, according to the National Pancreas Foundation (NPF).

Your pancreas is made up of two small glands deep in your belly. One of its functions (the exocrine function) is to release enzymes that help break down the food you eat so your body can absorb its nutrients. Some people have diseases or conditions that affect the ability of their pancreas to release these enzymes. These include a tumor, pancreatic surgery, chronic pancreatitis (inflammation of the pancreas), cystic fibrosis, and poorly responsive celiac disease, according to a review of EPI diagnosis and treatment concepts published in theWorld Journal of Gastroenterologyin November 2013.

Doctors can sometimes treat EPI at its root cause, like with celiac disease, for example, says Timothy B. Gardner, MD, an associate professor of medicine at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. Otherwise, EPI symptoms need to be treated with diet, vitamin and mineral supplements, and pancreatic enzyme replacement therapy (PERT).

“The goal of EPI treatment is to replace the digestive function of the pancreas,” Dr. Gardner says. Here's how the three elements of EPI treatment can help do this.

Diet

Doctors used to recommend a low-fat diet for people with EPI because it prevents fat malabsorption, which can lead to bloating and diarrhea. But that recommendation has changed because of the risk of weight loss and fat-soluble vitamin deficiency, according to theWorld Journal of Gastroenterologyreport. Researchers found that most people with EPI who also take enzymes can tolerate a diet with a normal amount of fat.

Today, people with EPI are advised to eat plenty of fruits and vegetables, which are good sources of vitamins and minerals, Gardner says. Also, eating smaller meals more frequently may help reduce stomach pain.

However, it’s important to note that children with EPI who also have cystic fibrosis need a high-protein, high-fat diet with added salt so they don’t stunt their growth or lose too much weight, according to the Cystic Fibrosis Foundation.

Vitamin and Mineral Supplements

“Fat-soluble vitamins A, D, E, and K are the vitamins to worry about,” Gardner says. Your doctor may recommend that you take them daily along with antioxidants — vitamin C and selenium —– to help “treat a pancreas that’s inflamed or under metabolic stress,” Dr. Whitcomb says. However, people with EPI who take a successful dose of pancreatic enzymes may not need vitamin supplements, he says.

Pancreatic Enzyme Replacement Therapy (PERT)

PERT can help you manage EPI and prevent malabsorption and gastric discomfort — but you must work with your doctor to determine how much enzyme replacement you need because everyone is different, according to Pancreatic Cancer Action (PCA), a nonprofit organization. “Start with a moderate dose and adjust as necessary depending on your symptoms,” Gardner says. You can be tested after a few months to see how you’re responding.

It’s important that you take the enzymes just before and during meals or snacks, not after you eat, PCA notes. And take your medication with cold — not hot — drinks because heat can damage the enzymes.

Pancreatic enzyme supplements are capsules that contain a mixture of digestive enzymes. They include lipase to break down fat, protease to assist with digestion of protein, and amylase for carbohydrates. The more fat in your meal, the higher dose of enzymes you’re likely to need, Whitcomb says.

PERT can cause diarrhea or constipation, nausea, and gastric upset, according to PCA. You may need to experiment and find a brand you can best tolerate because different manufacturers use different coatings. If you take the enzymes with antacids, they may not be as effective, according to the Pancreatic Cancer Network.

What Else You Can Do for EPI

In addition to taking these three main EPI treatment steps, it’s a good idea to abstain from alcohol and smoking. Excessive drinking can damage the pancreas, according to the National Institutes of Health. Smoking elevates your risk for pancreatic diseases, including cancer and pancreatitis, according to the American Pancreatic Association.